Premature birth

23rd Dec, 2013

It is very difficult to know which babies will be premature and which ones will be delivered on time. However if your labour and delivery does begin early then you will be pleased to know that there are many things doctors can do to ensure that your baby comes out healthy and ready for the world.

What does a premature birth look like?

Well to paint a picture in your mind; a normal pregnancy lasts between 37 and 42 weeks and so anything before this counts as a premature birth. Another name for premature birth is a preterm birth and these terms are often used interchangeably.

Symptoms?

Signs of a premature birth are really that of labour. Things that you may notice is that you have bleeding from your vagina, a new pain in your lower back, cramping pains or contractions, or broken waters that looks like a watery discharge coming out of the vagina. If you do happen to go into labour before the normal time then you will need to visit hospital for treatment. You must never delay asking for help.

If the doctor or midwife believes that there is a possibility that you may go into labour early they may suggest you get a foetal fibronectin test. This is a test that helps to tell if you are going into labour and is taken via a swab in your vagina. This test is not suitable for all pregnant women and your doctor or midwife will let you know if it is right for you.

Treatment!

When you go into labour there is really not much that can be done to stop it except for delivering the baby. However there are certainly a range of treatments that can be used to help the baby out. The idea of these treatments is to give your baby a little more time to mature and grow. Another good thing about medications that slow the process down is that they can be used to give the steroids a chance to work in order to speed up your baby’s growth and development.

One of the chemicals that are used to delay the birth of a premature baby is called progesterone. This is one of the major female hormones and it can be given as either a vaginal tablet or as an injection. There is no identification of harm to either the mother or the baby as a result of taking this medication. However there are no suitable studies that look at how well these babies have done in the long term in relation to those in whom the treatment was not given.

Some women have a weak cervix (that is the opening to you uterus or womb), stitches can be places into this by doctors in an attempt to stop your cervix from opening too early. There is mixed research on the use of this method and one must remember that this is not useful for all women and only in those select group who have the problem of a weak cervical opening. Also these stitches are far more effective if they are placed in early pregnancy and they may even start a labour of they are put in too late.

If you have an infection in your vagina caused by different kinds of bacteria then your chance of having a preterm labour is much higher. You can take antibiotics to kill the bacteria that are residing there; however there are many studies that suggest this does not make much of a difference in terms of having a premature birth or not. Some doctors used to think that resting in bed in the late stages of pregnancy may stop the baby from coming out early; however research has shown that this is certainly not the case. In some cases doing this may even make a preterm birth more likely.

As mentioned earlier there are treatments that can delay the delivery of the baby. If you happen to go into labour before 34 weeks of pregnancy then your doctor may decide to try and prevent the baby from coming for as long as possible. Delaying the delivery in this case allows more time for the baby to grow and develop and so is very important to attempt. There are a class of drugs known as calcium channel blockers and these delay delivery by reducing the contractions. These seem to be more effective than most other drugs and do not tend to cause as many side effects.

There is another class of medications known as beta-mimetics and these have also been used to try and prevent these early contractions. There is now good research that shown these are not very effective and they can cause serious side effects such as headache, sickness, breathlessness, palpitations, or chest pain. As well as all of the above side effects they can also increase the baby’s heart rate. If the water breaks before 37 weeks of pregnancy then it is a good idea to give antibiotic injections before labour starts as this can delay delivery for up to one week. This will allow your baby to have more time to grow. Also antibiotics are good at preventing infection from reaching the womb and causing harm to the baby. It is important to note that antibiotics will not be effective if the waters have already broken.

As well as all of this there are also treatments that help to protect the baby from harm. If your baby is less than 34 weeks in the womb then it is advisable to have a steroid injection in order to allow your baby to grow and develop more quickly. By speeding these things up your baby will have a better chance of being born healthy and will have a lower risk of getting many diseases in later life. You should have them at least 24 hours before the baby is born in order for them to have a good deal of effect. There is really convincing evidence that states your baby is less likely to have brain damage, lung disease, or die as the result of a steroid injection. There are also very few, if any side effects associated with a steroid injection.

There are some doctors who believe that it is much safer for a baby to be delivered by caesarean section. However this is more a personal thing as there is no evidence to support this. There is research that comments on the negative effects of caesarean sections saying that they are bad for the mothers and do not improve the outlook for the baby. Your doctor will keep you well informed as to whether you will be having a caesarean or a normal vaginal birth; however you must remember that situations can change throughout labour and you should be ready for anything.

Outcome?

If your baby is born after 32 weeks then there is a good chance that it will do well. Babies of prematurity are usually small and will require a degree of hospital support for longer than most term babies. In the long term babies born after 32 weeks will do well in the future and there is no major difference between these babies and babies born at the correct time. When babies are born before 32 weeks they may be very small and underdeveloped.

These babies will generally need special care and will usually need to be housed in a special little glass box called an incubator for a small period of time. In some cases a life support machine is required to help them breathe. There are many known health problems that can affect very premature babies into later life; however care for these babies is now better than ever and premature babies born these days are generally in pretty good hands.

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